Definition & Overview

Total shoulder replacement is a surgical procedure that replaces damaged shoulder joint with plastic or metal components, as the treatment for shoulder arthritis. Also known as total shoulder arthroplasty (TSA), it is intended to reduce pain and swelling, and to restore function and mobility in patients with end-stage arthritis of the shoulders.

Usually performed by an orthopaedic surgeon, the ends of the damaged upper arm bone as well as the shoulder bone are removed, and replaced with prosthetic parts that are cemented in place. The artificial components eventually integrate with the neighbouring bone structures as the movement becomes fully restored in the affected area.

Arthritis of the shoulder occurs when the cartilage and tendons in the upper shoulders deteriorate, usually due to age. As the joint surface progressively wears out, some areas of the bone become exposed and joint surfaces become rough. These result to friction and abrasion during movement, causing shoulder joints to become inflamed. This leads to severe pain, stiffness and often, loss of mobility in the shoulder area. This condition can be solved by a total shoulder replacement procedure.

Who Should Undergo and Expected Results

Patients who experience intolerable shoulder pain and stability caused by any of the following conditions may consider the procedure:

  • Osteoarthritis – This is the most common reason for shoulder replacement and refers to age-related arthritis caused by the degeneration of cartilage
  • Rheumatoid arthritis – A condition characterised by the inflammation of the membrane that surrounds the shoulder leading to cartilage degradation
  • Post-traumatic arthritis - As the term implies, this is a type of arthritis that occurs following a serious injury
  • Avascular necrosis - A very painful condition caused by lack of blood supply to the shoulder bone
  • Rotator cuff tear arthropathy - A condition characterised by chronic rotator cuff tear, leading to arthritis
  • Severe fracture - Fractures may cause the head of the upper bone arm to break or crack. In some cases, the only treatment available to restore shoulder appearance and function is total replacement
    Patients who will benefit from total shoulder replacement are those that:

  • Experience severe shoulder pain that disables them from performing normal activities such as reaching, dressing, washing, and going to the toilet

  • Experience severe pain in the shoulders even while resting that interferes with normal sleep
  • Persistent weakness, numbness, and loss of motion in the shoulder
  • Shoulder pain that does not go away even with anti-inflammatory medications, cortisone injections, painkillers, or physical therapy.
    The procedure has a high success rate in relieving pain caused by shoulder arthritis. After the procedure, physical therapy is performed to restore mobility in the shoulders.

How is the Procedure Performed?

Before TSA surgery, prior preparations have to be made. The orthopaedic surgeon may ask for a complete physical examination weeks before to ensure that the patient is medically fit for surgery.

Shoulder replacement is done under general or local anaesthesia and is highly technical. After the anaesthetic is in effect, an incision is made at a pre-planned location across the front of the shoulder to allow the surgeon access to the joint. Certain tendons are cut to remove the damaged and arthritic areas. The removed structures are then replaced with implant socket, ball, and stem component prosthetics that are carefully chosen to best match the anatomy. Surgeons also make sure that the new shoulder joint is not too loose or too tight to ensure proper restoration of muscle balance.

After the prosthesis is in place, the tendons and muscles are carefully repaired back and skin layers closed to complete the procedure. The entire surgery lasts two to three hours after which, patients spend about two hours in the recovery room and a few days in the hospital for monitoring.

Directly after a total shoulder replacement, patients feel some degree of surgery-related pain. However, the intensity is much less in degree compared to the pain felt prior to surgery. Antibiotic medications may be administered to prevent infection. To protect the shoulder area, a sling may be used for support for the next 2 to 4 weeks.

Physical therapy usually begins a day or two after surgery when pain becomes more manageable. The sooner the rehabilitation starts, the sooner it is for the patient to regain strength, flexibility, and mobility to the shoulders. The success of the operation is also highly dependent on physical therapy.

Possible Risks and Complications

Success rates of total shoulder replacement are very high. However, just like any surgical procedure, there is some degree of risk involved in this procedure. Complications rarely occur, and may include shoulder stiffness, infection, complications due to an adverse reaction to anaesthesia, nerve damage, instability of prosthetics, and loosening of glenoids.

References:

  • Devinney DS, et al., (2005). Surgery of shoulder arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 1, pp. 995-1015. Philadelphia: Lippincott Williams and Wilkins.

  • Nam D, et al. (2010). Reverse total shoulder arthroplasty: Current concepts, results, and component wear analysis. Journal of Bone and Joint Surgery, American Version, 92(Suppl 2): 23-35.

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